Type III Hyperlipoproteinemia: The Forgotten, Disregarded, Neglected, Overlooked, Ignored but Highly Atherogenic, and Highly Treatable Dyslipoproteinemia

Abstract

Cardiovascular risk is so high in type III hyperlipoproteinemia that type III, just like heterozygous familial hypercholesterolemia (FH)2, is a treat-on-diagnosis disorder (1–3). Tragically, although severe hypercholesterolemia is easy to recognize, type III hyperlipoproteinemia cannot be diagnosed using a conventional lipid panel (4) and the original diagnostic tools—electrophoresis and ultracentrifugation—are available in only a miniscule number of clinics (1). Thus, type III cannot be diagnosed in regular clinical care using regular diagnostic tools. Moreover, while the importance of FH is recognized by all the major lipid guidelines, even the existence of type III hyperlipoproteinemia is barely acknowledged, if at all, by the same groups. Consequently, those patients with type III are lumped and dumped with all the others with mixed hyperlipidemia and the result, tragically, can be no treatment when treatment is indicated. In a wonderful paper (3), Paul Hopkins and his colleagues referred to type III hyperlipoproteinemia as the “forgotten phenotype.” Nothing has changed and so the extended title of this editorial.